Epidemiology

Low CD4 cell count elevates cancer risk in patients with HIV

Last Updated: 2009-10-07 18:30:09 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Immunocompromise is the strongest risk factor for both AIDS-defining and non-AIDS-defining cancers in HIV-infected patients, French investigators report.

Thus, treatment with combination antiretroviral therapy (cART) early in the course of HIV infection to maintain CD4 cell counts would be most beneficial in reducing the incidence of cancer in this population, Dr. Dominique Costagliola, at INSERM and Universite Pierre et Marie Curie in Paris, and coworkers advise in The Lancet Oncology published online on October 8.

Dr. Costagliola's team conducted a study of these factors because "the relative roles of immunodeficiency, HIV viral load, and cART in the onset of individual cancers have rarely been examined."

With data from the French Hospital Database on HIV for the period 1998 to 2006, they investigated the incidence of AIDS-defining cancers (Kaposi's sarcoma, non-Hodgkin lymphoma, cervical cancer) and non-AIDS-defining cancers (Hodgkin's lymphoma, lung cancer, liver cancer, and anal cancer), in 52,278 HIV patients with more than 250,000 person-years of follow-up.

The median baseline CD4 count was 325 cells per microliter and the median viral load was 4.18 log-10 copies per mL; cART was taken for the total follow-up period by 73% of subjects.

Each type of malignancy was analyzed separately, using Poisson regression to test 78 different models.

"Current CD4 cell count was the only factor predictive of Hodgkin's lymphoma, lung cancer, and liver cancer," Dr. Costagliola and associates report, "whereas current CD4 cell count, current viral load, and absence of cART therapy were risk factors for Kaposi's sarcoma and non-Hodgkin lymphoma."

Cervical cancer was associated with current CD4 cell count and absence of cART. The risk of anal cancer increased with cumulative duration of CD4 counts < 200 cells per microliter and with the cumulative duration of viral load > 5 log-10 copies per mL.

In addition to their recommendation to use early treatment with cART to maintain CD4 counts above 500 cells/microliter, the research team holds that "cancer-specific screening programs need to be assessed in patients with HIV."

Lancet Oncol 2009.